factors influencing ethical decision …...overall the results of this study showed that factors...
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FACTORS INFLUENCING ETHICAL DECISION MAKING AMONGPSYCIDATRIC NURSES AT MATHARI HOSPITAL IN NAIROBI.
A DISSERTATION SUBMITTED IN PARTIAL FULFILMENT OF THEREQUIREMENTS FOR THE AWARD OF THE DEGREE OF MASTER OF
SCIENCE IN NURSING (MENTAL HEALTH AND PSYCHIATRIC NURSING) OFTHE SCHOOL OF NURSING SCIENCES, UNIVERSITY OF NAIROBI
BY
IRENE GACHERI MAGETO
REG. NO. H561P170449/07
Septem ber 2009
-
DECLARATION
I, Mageto Gacheri Irene declare that this dissertation is my original work and has not been
presented for an award of a degree in any other university.
Signature ..~I:~ Date.J.(fi?r.fqJ. .
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CERTIFICATE OF APPROVAL
This dissertation has been submitted with our approval as the University Supervisors.
1. The late Prof. Joyce 0 Musandu,
PhO, MScN, DAN, KRN, KRM, KRCHN.Oirector and Senior Lecturer,
School of Nursing sciences, University of Nairobi
2. Dr Margaret N Chege,
PhO, MPHE, BScN, DAN, RN/RM/PHN
Lecturer, Sch 01 of Nursing Sciences, University TNairObi
Signature... .d(;...........Date.HfL~J
3. Dr James Mwaura,
PhD, MSc, BScN
Lecturer, School of nursing Sciences, University of Nairobi
Signature ~ ..~: Date /6.:~.tep..~1
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DEDICATION
To my husband Peter, son Teddy and daughter Chrystal for their patience, support and
encouragement during the writing ofthis proposal. You are the wind beneath my wings!
To my late brother Mwirigi. May you rest in eternal peace Mbiiri.
To all psychiatric nurses who dare to care for the mentally ill.
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ACKNOWLEDGEMENT
I wish to acknowledge the help of my supervisors the late Prof. Joyce Musandu, Dr. Margaret
Chege and Dr. James Mwaura in working and walking with me through this dissertation.
Without your help this project would not have been a success. Please keep up the helping
spirit.
I also wish to appreciate the efforts ofMrs Mirriam Wagoro for guiding me through the right
path of thinking in research terms and constructive critique of the first draft of this work.
Many thanks go to Mr. Lawrence Muthami for teaching me biostatistics, Dr Michael Bowen
for helping me with statistical analysis of data and to Mr. Martin Mutisya for being available
for biostatistical consultations.
I thank my colleague Nancy Michire for her constant appraisal, critique and encouragement.
You always kept me on my toes! Thanks also to the administration of Mathari Hospital for
allowing me to access my study population and to all those nurses who participated in the
study. Many thanks to my research assistants for their dedication and support through out the
data collection period.
I appreciate the School of Nursing Sciences of the University of Nairobi for the good learning
atmosphere.
To you all, GOD BLESS YOU abundantly!
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TABLE OF CONTENTS
DECLARATION .ii
CERTIFICATE OF APPROVAL iii
DEDICATION iv
ACKNOWLEDGEMENT v
TABLE OF CONTENTS vi
LIST OF FIGURES ix
LIST OF TABLES x
LIST OF ACRONYMS AND ABBREVIATIONS xi
DEFINITION OF OPERATIONAL TERMS xii
ABSTRACT xiii
CHAPTER ONE: INTRODUCTION 1
1.1 Background 1
1.2 Research problem 2
1.3 Justification of study , 3
1.4 Research questions 3
1.5 Study objectives 4
1.5.1 Main Objective 4
1.5.2 Specifc Objectives: 4
1. 6 Hypothesis 4
CHAPTER TWO: LITERATURE REVIEW 5
2.1 Introduction 5
2.2 Ethical decision making 5
2.3 Theoretical framework 9
2.4 Ethical principles 10
2.5 Professional codes and international agreements 11
CHAPTER THREE: MATERIALS & METHODS 13
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3.1 Research design 13
3.2 Variables under study 13
3.2.1 Independent variables 13
3.2.2 Depedent variable 13
3.2.3 Confounding variables 13
3.3 Study area 14
3.4 Study population 14
3.5 Inclusion and exclusion criteria 14
3.5.1 Inclusion criteria 14
3.5.2 Exclusion Criteria 14
3.6 Sample size determination 15
3.7 Sampling procedures 16
3.8 Study instrument. 18
3.9 Training of research assistants 18
3.10 Validity and reliability 18
3.11 Data collection 18
3.12 Data management 19
3.12.1 Data cleaning and entry 19
3.12.2 Data analysis and presentation 19
3.13 Ethical considerations 19
3.14 Study assumption 20
3.16 Conceptual framework 20
CHAPTER FOUR: RESEARCH RESULTS 21
CHAPTER FIVE:DISCUSSION, CONCLUSION AND RECOMMENDATIONS 33
5.1 Discussion 33
5.2 Conclusion 39
5.3 Recommendations 39
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TIME PLAN 40
BUDGET 41
REFERENCES 42
APPENDICES 46
APPENDIX I: Questionnaire for nurses 46
APPENDIX II: Focus group discussion 51
APPENDIX III: Consent explanation form 52
APPENDIX IV: Letter of approval from knh ethics and research committee 53
APPENDIX V: Letter of Approval. 55
APPENDIX VI: Letter of authorization 56
APPENDIX VIII: Map of showing location ofMathari Hospital... 57
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LIST OF FIGURES
Figure 1: Interaction between variables affecting ethical decision making 20
Figure 2: Respodents age 21
Figure 3: Respodents gender 22
Figure 4: Respodents' marital status 22
Figure 5: Respodents qualifications 23
Figure 6: Respodents designation 24
Figure 7: Staffing ratios 26
Figure 8: Results of disclosure of patients diagnosis 28
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LIST OF TABLES
Table 1:Sampling frame 17
Table 2: Respondents years of practice 25
Table 3: Respodents' Psychiatric experience 26
Table 4: Nurses reaction to patients refusal of medication 29
x
BScN
DOH
ECHR
ECN
EN
ERB
FMA
ICN
KNH
KRM
KRN
MScN
PMHNE
SPSS
UK
UNWMA
LIST OF ACRONYMS AND ABBREVIATIONS
Bachelor of Science in Nursing
Declaration of Helsinki
European Commision on Human Rights
Enrolled Community Nurse
Enrolled Nurse
Ethical Review Board
Finnish Medical Association
International Council of Nurses
Kenyatta National Hospital
Kenya Registred Midwife
Kenya Registred Nurse
Master of Science in Nursing
Psychiatric Mental Health Nursing Education
Statistical program for social sciences
United Kingdom
United Nations
World Medical Association
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DEFINITION OF OPERATIONAL TERMS
Ethical decision: A moral decision made in regard to patient care.
Ethical decision making: Trying to distinguish right from wrong in situations without clear
guidelines.
Ethical dilemma-A situation that arises when the nurse is expected to choose between two
equally unsatisfactory alternatives.
Ethical theory: A theory that deals with the standards and principles of moral reasoning and
enables the nurse to reach a conclusion about what should be done.
Nursing ethics: The formal study of ethical issues that arise in the practice of nursing .In
this study, it will be viewed as a guide to the analysis used by nurses to make ethical
judgement.
Psychiatric nurses: All licenced nurses working at Mathari Hospital.
Psychiatric nursing:The specialty within nursing that deals specifically with human
responses to mental problems.
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ABSTRACT
Ethical decision making is the process of trying to distinguish right from wrong in situations
without clear guidelines. While ethical dilemmas confront nurses in all areas of nursing
practice, those that occur in psychiatric nursing are more challenging than those occurring in
other areas of nursing. This is because the decrease in mental ability of psychiatric patients
leads to vulnerability which evokes ethical difficulties for the psychiatric nurses.
This was a descriptive cross-sectional study aimed at identifying the factors that influence
ethical decision making among psychiatric nurses in Kenya. It was carried out at Mathari
hospital in Nairobi.
The study aimed at identifying factors that influence the process of ethical decision making
by the psychiatric nurses in their clinical practice. The study hypothesis was that there is no
relationship between nurses' demographic characteristics and the way they make ethical
decisions.
Quantitative data was collected using a self administered questionaire which was developed
and distributed to 152 randomly sampled psychiatric nurses at Mathari hospital. Qualitative
data was collected via a focused group discussion which comprised of eight randomly
selected charge nurses. Data was categorized and coded depending on the variables. Data
entry was done by use of SPSS (version 16.0) statistical package. Desciptive and inferential
statistics were used as appropriate for data analysis. For example, Spearman's Rank order
was used to express correlation between variables. Qualitative data from focused group
discussions was ana lysed manually.
Overall the results of this study showed that factors influencing nurses ethical decision
making were professional experience(r=0.040,p=0.01), workload (rho=0.227,p=0.042),
psychiatric nursing experience(r= 0.037,p= 0.01) and gender(rho=0.277,p= 0.013). There is
need to consider knowledge and skills obtained through psychiatric care specializations when
posting nursing staff to the psychiatric care areas. More research (using both quantitative and
qualitative approaches) need to be done to identify what other aspects of the clinical
environment affect ethical decision performance by nurses.
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